First Name: *
Last Name: *
Preferred Name (if different than first):
Email *
Primary Phone Number: *
Work Phone Number:
Mobile Phone Number (if not given above):
Spouse's Name (if married): *
Please provide name, age/grade, birthdate, profession of faith (yes/no?), baptism (yes/no?) for each of your children still living at home.
Church to which you last belonged or attended regularly: *
What is the denomination of your previous church? *
Phone number of previous church or its pastor: *
When did you last attend this church? *
Approximately how long did you regularly attend this church? *
What were your reasons for leaving? *
Have you notified the church of your plans to join us? * Yes No
Were you in good standing with the church when you left? * Yes No (please explain)
If you answered "No" above, please briefly explain: *
What evidence do you see in your life which would give you assurance that you are truly a child of God? *
How would you describe your present spiritual condition? Please be specific. *
Have you been baptized by immersion following your conversion? * Yes No
If so, what was the approximate date of your baptism? *
What was the name of the church in which you were baptized? *
If you have NOT been baptized by immersion following your conversion, do you now wish to be baptized in obedience to Christ's instructions? * Yes No
In what areas of ministry have you served or would desire to serve?
While we do not require the same level of commitment to our statement of faith from our members as we do from our leadership, we would like to know if you have any concerns. Are you aware of any disagreement between your beliefs and those of our confession, as stated in the church's constitution and bylaws? * Yes (please explain) No
If you answered "Yes" above, please explain: *
Are you willing to discuss your giving records with the elders when they conduct the membership interview? * Yes No (please explain)
If you answered "No" above, please explain: *
Do you have any questions related to this application or any specific issues which you would like for us to discuss at the membership interview?
